Understanding Obsessive Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a chronic mental health disorder characterized by persistent, intrusive thoughts known as obsessions, and repetitive behaviors called compulsions.¹ OCD is one of the most common mental health conditions.² For most people, symptoms of OCD begin in childhood or adolescence.³ OCD is challenging because it causes great distress and significantly impacts people’s lives. Individuals with OCD can become overwhelmed by their thoughts and anxiety and feel like captives to the rituals that help take away that anxiety. For example, someone might feel compelled to wash their hands dozens of times a day to alleviate the fear of germs, which can lead to cracked skin and severe distress. 

This page will explore the symptoms, diagnosis, and treatment options for those living with OCD.

Symptoms of OCD

The symptoms of OCD are consuming to the point that they can cause individuals living with the condition to experience major distress or interfere with their daily lives. Stress from environmental factors or personal experiences can contribute to a worsening of symptoms.⁴

Symptoms of OCD can be categorized as either obsessions or compulsions. A person living with OCD might have obsessions, compulsions, or both.³

Obsessions

Obsessions are intrusive, unwanted, and distressing thoughts, urges, or images that come into a person’s mind that keep repeating or returning.³ Obsessions can hinder concentration and normal activities for people with OCD because they try to ignore or counteract them with other behaviors.¹

Common examples of obsessions include:

• Horrifying thoughts, mental pictures, or urges
• Fear of germs and an unending desire for cleanliness or purity
• Taboo thoughts about sex or religion
• Aggressive thoughts about hurting oneself or others
• The need to have things symmetrical or in perfect order

Compulsions

The second symptom of OCD is compulsions or ritual behaviors that a person with OCD feels they must do to help them deal with or stop the obsessive thoughts and the feelings those thoughts create.¹ Because an individual with OCD feels compelled to act this way in response to obsessions, these actions are called compulsions. Compulsions can be physical actions or mental actions, and people might feel the need to repeat these actions over and over.³

Common examples of compulsions include³: 

• Washing hands repeatedly until the skin cracks
• Excessive cleaning
• Ordering or arranging things in a particular symmetrical way
• Repeatedly checking things, like making sure the door is locked or the oven is off
• Uncontrollable counting or repeating words

OCD Diagnosis

Is there an OCD test?

What is the process for obtaining an official OCD diagnosis? There are some signs that might make you feel you need to get screened for OCD, such as:

• Upsetting thoughts that you don’t want keep popping into your head and won’t stop
• Feeling like you have to do something to get rid of those thoughts or prevent something bad from happening  

These are examples of obsessions and compulsions and signal that OCD might be at play vs. particular personal preferences for cleanliness or order that many people have.

No physical exam, technology, or laboratory-based procedure is used as an OCD test. OCD testing involves a conversation with a qualified mental health professional, such as a therapist, where they will ask questions to evaluate the type and severity of symptoms. In general, a diagnosis of obsessive-compulsive disorder means an individual is experiencing:

• Either obsessions or compulsions or both on most days for at least two weeks
• Symptoms that last more than 1 hour a day
• Significant distress from obsessions or compulsions
• Interference with their normal routine, such as job or school responsibilities, social activities, or relationships, due to symptoms¹

A mental health professional may use a standardized screening tool such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), or the Florida Obsessive-Compulsive Inventory (FOCI), or the Dimensional Obsessive-Compulsive Scale (DOCS) to help assess for OCD.⁵ 

It’s become somewhat common for some people to say “I’m so OCD” simply because they prefer things to be in order or clean. It’s best to avoid claiming a disorder when you haven’t been diagnosed because it minimizes the experiences and challenges of someone living with diagnosed OCD. Obsessive-compulsive disorder is not anyone’s choice or preference.

OCD Treatment

Several types of treatment are effective for OCD and with treatment, people with OCD can overcome the obsessive thoughts and ritual behaviors that have controlled their lives.³  

Cognitive Behavioral Therapy, or CBT, is an effective psychotherapy for OCD. In CBT people learn tools and skills to challenge their thoughts and change behaviors.¹ There is a specific cognitive behavioral therapy known as Exposure and Response Prevention, or ERP, that is designed to help manage and challenge obsessive thoughts and delay compulsive rituals until a person feels less anxious. This therapy is currently the standard of care for OCD treatment and often works best in combination with medication.³ 

ERP is the recommended treatment because it has years of research and evidence supporting its effectiveness. In ERP, individuals living with OCD work with a mental health care professional on:

• Exposure: Tolerating the scary obsessive thoughts
• Response Prevention: Not acting on the thoughts or engaging in compulsive behaviors

ERP treatment for OCD helps individuals reset the areas of the brain that are overactive and therefore creating obsessive thoughts back to typical levels over time. It helps them remind themselves that their brain is sending false alarms due to OCD and their job is to accept and ignore the alarm.⁶ 

Other therapeutic approaches may also be helpful for OCD, such as acceptance and commitment therapy, mindfulness-based cognitive therapy, and therapy that includes family members.

OCD Medication

All OCD medications affect chemicals in the areas of the brain related to thinking. This allows people with OCD to have more control over their obsessions by practicing, challenging, and managing these thoughts. These medications make it easier for people to work in ERP therapy to prevent compulsive rituals.³ 

Several medications treat OCD, all of which are also used for depression. The most common medications for OCD are called selective serotonin reuptake inhibitors, or SSRIs. SSRI medications are not addictive and any side effects they have are usually manageable. Medications for OCD should be used in close consultation with an experienced psychiatric prescriber.⁴

Summary

Living with OCD involves managing distressing obsessions and compulsions that can disrupt daily life and cause significant emotional strain. While there is no single physical test for diagnosing OCD, mental health professionals can identify the disorder through careful evaluation of symptoms. Effective treatment options include Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP), sometimes combined with medication. These treatments help individuals reduce obsessive thoughts and compulsive behaviors, enabling them to regain control over their lives and improve their overall well-being. OCD can take over people’s thoughts and behaviors. But with the right combination of therapy and medications, people can take their lives back.